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May 2018

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MAY 2018

Inside this issue ORAL HYGIENE

Is Your Tongue Causing Your Health Problems? Pat Pine, RDH

Providing Preventative Dental Care in the Community for Persons with Special Needs: Closing the Gap Between Mobile and Conventional Dental Clinics in the Community Josie Costantiello, RDH

5 Life Saving Minutes: Introducing the North American ‘Check Your Mouth’ Campaign Jo-Anne Jones

DEPARTMENTS 5

Lead by Influence

Irene Ianuc, BSc, RDH, CTDP

COMMUNICATION

EDITORIAL

What Your Ears May Tell Us About Your Health

Strategic Systems for a Successful Practice: Dynamic Teams – Attitudes and Platitudes Lois Banta

NEWS Alcohol Drinks Linked to Harmful Oral Bacteria Rising Cavity Numbers Cause Return of Fluoride in Ontario Cities Flavoured Drink Reduces Dental Plaque Through Consumption

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MAY 2018

39 www.oralhealthgroup.com

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EDITORIAL

Lead by Influence

Jillian Cecchini Managing Editor

MAY 2018

“Leaders become great not because of their power but because of their ability to empower others”. For the past few years our company has attended MagNet, which is Canada’s premier professional development and networking conference for magazine media professionals. MagNet was developed to meet the industry’s growing need for targeted, thought-provoking information through insightful, accessible and affordable learning. It is a collaborative effort from Canadian associations to deliver sessions, workshops and keynote speakers from North America’s leaders in magazine publishing. When I was deciding which sessions to attend, one in particular caught my attention: “How to Tap into The Power of Influencers”. The goal of the session was to learn how industry leaders and influencers can lend their voice to create compelling and share-worthy content. Throughout the session, I learned that influencers have a unique form of power. Using a multi-platform approach, influencers have the ability to create and encourage dialogue and drive engagement. They are extremely passionate and believe in their brand. They have a unique voice and provide quality content (or care) that aligns with their niche audience. They not only focus on relatability but are also accessible and credible. And perhaps most importantly, influencers have gained the trust of their audience. Sound familiar? The day after MagNet, the team of Oral Health was on the tradeshow floor for the Annual Spring Meeting in Toronto. The show was full of industry and

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dental professionals, eager to engage with their peers, interact with companies and attend sessions delivered by key opinion leaders (KOLs), all to learn and enhance their skills within the profession. The dental industry relies on the positive advocacy of KOLs, who are seen as trustworthy, and have reputations that enhance the believability of the topic they are discussing. Every influencer is different but one goal that all KOLs share is to capture attention and prestige within their respective communities. Tradeshows, for example, are an ideal platform for industry leaders to present on topics that are beneficial and educational for attendees. From my experience sitting in on sessions, there is always a strong focus on the content value for the targeted audience. If you want to be the best, it’s beneficial to learn from the best. Taking advantage of the information available is essential for personal and professional growth. We should always maintain the mindset to become leaders within our respective fields. No matter what the position – an experienced KOL, dentist, hygienist, office manager, or even an editor like myself, the importance of mastering our skills and exuding passion is essential. The ability to influence others is a fundamental skill that leaders must perfect in order to be effective. If we are inspiring others by our determination and willingness to evolve, we are all leaders. Be aware of your presence and aim high. Leadership is not a position or a title; it is action and example. It’s simple – our success lies within our ability to inspire others.

May 2017

oralhygiene

NEWS Alcohol Drinks Linked to Harmful Oral Bacteria When compared with nondrinkers, men and women who had one or more alcoholic drinks per day had an overabundance of oral bacteria linked to gum disease, some cancers, and heart disease. By contrast, drinkers had fewer bacteria known to check the growth of other, harmful germs. These are the main findings of a study published in the journal Microbiome online April 23 and led by NYU School of Medicine researchers. “Our study offers clear evidence that drinking is bad for maintaining a healthy balance of microbes in the mouth and could help explain why drinking, like smoking, leads to bacterial changes already tied to cancer and chronic disease,” says study senior investigator and epidemiologist Jiyoung Ahn, PhD.

A NEWCOM Media Inc. Publication

Managing Editor: Jillian Cecchini 416-510-5125 jillian@newcom.ca

Associate Publisher: Hasina Ahmed 416-510-6765 hasina@newcom.ca

Assistant Editor: Krysten McCumber (416) 510-6777 krysten@newcom.ca

Director, Business Development: Tony Burgaretta 416-510-6852 tonyb@newcom.ca

Circulation: Mary Garufi 416-614-5831 mary@newcom.ca

Account Manager: Holly Power 416-510-6846 holly@newcom.ca

Advertising Services: Karen Samuels 416-510-5190 karens@newcom.ca

Classified Advertising: Karen Shaw 416-510-6770 karen@newcom.ca

Art Direction: Michael Chimienti

Flavoured Drink Reduces Dental Plaque Through Consumption DoseBiome has announced their new findings that qii, the world’s first functional drink for oral health, can reduce up to 52% of dental plaque with each serving. This news coincides with the addition of three new fruit flavors to their lineup – White Peach, Pomegranate and Lychee Tea. A resident within Johnson & Johnson Innovation, JLABS @ Toronto, the team at DoseBiome has spent the past few years researching the bacteria and plaque that cause cavi-

ties, gingivitis and bad breath. “The oral microbiome is an emerging area of research centered around the relationship between beneficial and harmful bacteria. Our team is comprised of PhDs from the fields of microbiology, food science and dentistry who are dedicated to finding innovative ways to improve oral health,” says founder Ted Jin. “In understanding harmful bacteria and how they form plaque, we have effectively found ways to reduce both, leading to the development of qii.”

Rising Cavity Numbers Cause Return of Fluoride in Ontario Cities The rising number of local oral healthcare issues including cavities has prompted the Windsor-Essex Health Unit board to unanimously approve a four-point plan that includes reintroducing fluoride into Windsor’s drinking water. The city opted to remove fluoride from its drinking water in 2013 with the proviso of revisiting the issue after five years. The decision also impacted Tecumseh and LaSalle, which buy their water from the city. “There’s a pattern of worsening oral healthcare in this community from 2011 to 2016,” said Dr. Wajid Ahmed, the health unit’s acting medical officer of health.

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MEDIA INC.

Chairman and Founder: Jim Glionna President: Joe Glionna Vice President, Publishing: Melissa Summerfield Director of Circulation: Pat Glionna

OFFICE: Located at 5353 Dundas Street West, Suite 400 Toronto ON M9B 6H8 Telephone 416-442-5600, Fax 416-510-5140. Oral Hygiene serves dental hygienists across Canada. The editorial environment speaks to hygienists as professionals, helping them build and develop clinical skills, master new products and technologies and increase their productivity and effectiveness as key members of the dental team. Articles focus on topics of interest to the hygienist, including education, communication, prevention and treatment modalities. Please address all submissions to: The Editor, Oral Hygiene, 5353 Dundas Street West, Suite 400 Toronto ON M9B 6H8

Subscription rates: Canada $25.00/1 year; $47.00/2 years; USA $46.95/1 year; Foreign $46.95/1 year; Single copies Canada & USA $10.00, Foreign $18.00. GST/ HST #103862405RT0001.Printed in Canada. All rights reserved. The contents of this publication may not be reproduced either in part or in full without the written consent of the copyright owner. From time to time we make our subscription list available to select companies and organizations whose product or service may interest you. If you do not wish your contact information to be made available, please contact us via one of the following methods: Phone: 416-614-5831; Fax: 416-614-8861; E-mail: mary@newcom.ca; Mail to: Privacy Officer, 5353 Dundas Street West, Suite 400 Toronto ON M9B 6H8 Canada Post product agreement No. 40063170. Oral Hygiene is published quarterly by Newcom Media Inc., a leading Canadian magazine publishing company. ISSN 0827-1305 (PRINT) ISSN 1923-3450 (ONLINE)

MAY 2018

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ORAL HYGIENE

IS YOUR TONGUE CAUSING YOUR HEALTH PROBLEMS?

E Pat Pine, RDH, COM™ is a national and international speaker with experience in a variety of clinical and non-clinical dental arenas. Her passion for safety and infection prevention has led to her speaking on OSHA and infection prevention for the last 25 years. Pat established a one-of-a-kind OSHA Training Boot Camp and widely acclaimed in-office training programs. Pat’s new professional niche is Orofacial Myology. Her advanced her knowledge as a Certified Orofacial Myologist (COM™) providing myofunctional therapy, this allows her to overlap both topics, keeping patients healthy while keeping their oral muscles in harmony. Pat’s speaking engagements are interactive and fun. To arrange a program, in-office, component, state or national meeting, contact Pat at www.info@musclesinharmony.com.

ver wonder what organ really controls our body? Most assume it is the heart. The heart pumps blood to the lungs, which is needed to breath efficiently. Both heart and lungs are vital to the human body’s machinery – but consider the tongue! Medical communities are surprised at this possible revelation. Is the tongue a muscle or an organ of the body? The tongue is comprised of intrinsic muscle and extrinsic muscle and is covered with mucous membrane. It is attached to a floating bone called the hyoid bone. This floating bone is attached to many muscles - anterior, posterior and inferiorly, which keeps it in place. This horseshoe shaped bone serves as an anchoring structure for the tongue and its surrounding muscles. This exceptional bone is found at the root of the tongue just above the thyroid cartilage, below the chin, at the midline of the neck. The four muscles above or superior to the hyoid bone provide attachment to muscles that form the floor of the mouth. But many other muscles are controlled by our tongue inferiorly or below the chin. They are attached to the collar bone. Hum, the tongue is attached to the collar bone? Didn’t know that!

WHY DO WE CARE ABOUT THIS HORSESHOE SHAPED BONE? This free-floating bone is not attached to another bone in the body.

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Positioning of the hyoid bone is the responsibility of the infrahyoid and suprahyoid muscles. These muscles are very important for the complete act of swallowing and action of the larynx. The four-infrahyoid muscles are referred to as “strap muscles” and are attached from the hyoid bone inferior to the clavicle, or scapula. Stay with me here. The suprahyoid muscles are attached above the hyoid bone and infrahyoid below the hyoid with attachment to the clavicle or collar bone. An ankyloglossia, or tethered oral tissue, also named tongue-tie, can be the cause of medical conditions that are not routinely diagnosed. Headaches, shoulder and neck pain can be caused by tight muscles attached to the hyoid bone. With a tongue-tie those suprahyoid muscles are typically tight, pulling on the tongue when it attempts to function, but cannot because it is anchored to the floor of the mouth. This restricts the tongue from normal movement and function. The tongue has many duties, including maintaining the airway, assisting with chewing, swallowing, and most importantly facial development, speech and digestion. When the tongue is developing in utero at about the fourth week, its first duty is to shape the maxilla. The tongue should reach the palate to form a nice wide horseshoe shape. When the frenum is tight, short or anchored to the floor of the mouth, this shape will not take place, nor will normal facial develMAY 2018

opment take place. Orthodontic treatment is sure to be scheduled in the future for patients with a tethered tongue, if it is not released at a very young age. Malocclusion is sure to develop. This singly attached muscle has not been able to do its job.

WHAT IS INSTIGATING THE PROBLEMS? It all starts at birth. A short, tight membrane underneath the tongue, called frenum, frenulum, frenula, attaches the tongue to the floor of the mouth. The oral cavity has seven frenums. Each one can be tethered or restrict normal movement. The tongue frenum is exceedingly strong and can restrict movement and normal function. It seems like an epidemic the past years that infants are challenged with tethered oral tissues, both tongue and lip ties. This can prevent normal development, because of breast or bottle-feeding issues, and they are often diagnosed with failure to thrive. Babies are not able to nurse with a tongue that is tethered. The tongue cannot create its peristaltic action (wave like) while breast feeding. The infant’s symptoms determine if the tethered tissues are to be non-invasive surgically released. These are all very real concerns. Families are already dealing with the many concerns of a new baby. Tethered oral tissues (TOTs) shouldn’t have to be one of them. Our tongue controls our body in ways we are unaware. The huMAY 2018

man body is amazing in the way it operates and functions together, seemingly without any thought on our part. Airway – The airway is the most valuable system in the human body. Without it the body would not be thriving. If the tongue is anchored or tethered too tightly to the floor of the mouth, movement and function are restricted. This can be the cause of snoring, sleep apnea, gagging and vocal sounds. Without a clear airway normal breathing cannot take place. Should the tongue fall back into the airway while sleeping, snoring erupts and disrupts households. During the day with a tethered tongue, the airway may be blocked and the only way to open the airway is to place the head in a forward position to breathe through the mouth. Open mouth posture can cause fatigue, brain fog, lack of attentiveness, and also hyperactivity. Breast feeding/Bottle feeding – This is impossible when the tongue is anchored to the floor of the mouth. Movement, function and freedom of the tongue are needed to allow for a good latch/seal on the breast or bottle. A good latch in turn creates suction to release nourishment. The infant needs to breast feed efficiently in order to keep the breast milk supply replenished. Pain and great discomfort occurs when the nursing infant’s tongue is tethered. It doesn’t mat-

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ter how tethered at this point. It is causing pain and frustration to the mother and frustration and failure to thrive to the infant. This can lead to developmental concerns. There are many other symptoms that are attached to tongue-tie and breast and bottle feeding i.e. clicking, gagging, gassiness, reflux. Children and adults can have health issues that are attached to tongue-ties. More information can be viewed in the book, Please Release Me – The Tethered Oral Tissue (TOT) Puzzle found at www.musclesinharmony.com. This book can give you answers to many of your own questions. Infants need to be evaluated by an experienced, knowledgeable professional who works with tongue-ties and lip-ties. Chewing – Without proper movement and function, the tongue cannot move food from side to side for sufficient chewing for complete digestion. It’s been stated that we need to chew our food 30 times before we swallow it. Not sure if that happens, as many people are in the eat and run mode. Cleaning of the Mouth – Freedom and movement is needed for the tongue to clean each and every tooth in the mouth. If it can’t reach to the posterior molars, 3rds included, it could be tethered. Facial Development – Our nose is not an ornament on our face but allows the body to keep functioning.

May 2017

oralhygiene

Nasal airway is important to breath filtered, moist, humidified air. There is a saying, “If we don’t use it we lose it!” This is true. When not using our nasal passages to breathe the mid-face will not develop or grow normally. Obstructive Sleep Apnea (OSA) – OSA has become an important topic of discussion and study in the dental and medical communities. It should be a topic of conversation with all patients, at each dental visit as it can impact life or death. Patients with sleep apnea can die from heart attacks. These patients are unaware that they snore or stop breathing at night or while taking a nap. Some patients are aware of their snoring, but feel it’s normal for their age or weight. This is not true. This involuntary period when breathing stops is called apnea. Normally, air is flowing through the nose to the lungs at all times. If the air space in the throat is too narrow the flow of air stops. Snoring is a trait of OSA. Symptoms include headaches, forgetfulness, grumpiness, irritability, poor job performance, depression, and loss of interest in sex. More severe health issues can be hypertension, heart disease, stroke, and diabetes. Proper diagnosis is essential followed by treatment. Open Mouth Posture – This is also called mouth breathing. Mouth breathing allows infections to enter the body easily since there is no filter via the oral cavity. The tonsils are present to help filter but many times they enlarge and become part of the problem with obstructive sleep apnea for children and

oralhygiene

adults alike. Mouth breathing does not allow proper respiration. The inhaled air mixes with nitric oxide (NO). NO is a vasodilator and enhances the uptake of oxygen. Breathing (or respiration, or ventilation) is the process of moving air into and out of the lungs to facilitate gas exchange with the internal environment, mostly by bringing in oxygen and flushing out carbon dioxide. Nasal passages act as a tunnel to filter, moisturize and humidify the air entering the lungs. The lungs will not perform correctly as they are struggling to provide concentrated oxygen for the body with non-filtered air. Every cell in the body is affected by mouth breathing due to the lack of essential oxygen. Other symptoms of mouth breathing can include: snoring, sleep apnea, headaches, migraines, hypertension, TMD – pain, dark circles under eyes, and ear and sinus infections. School Work – This can be hindered when the airway is compromised by the tongue, resulting in insufficient breathing. Foggy brain and fatigue can be common when sufficient oxygen is not getting to the brain. Mouth breathing, forward head posture, enlarged tonsils, sore throat from mouth breathing can all be symptoms causing school work concerns. These disorders can be evaluated and addressed by an Orofacial Myologist for myofunctional therapy. Speech – Communication is a must with or without cell phones. Our verbal language starts at a very young age. First words, cooing, sounds like mama, dada, are nor-

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mal for infants. Infants are mesmerized by our voice, tone and words. Movement of the tongue is important for pronunciation of words and working words into sentences. Without clear interaction with others, social speaking skills can be hindered. The tongue has several jobs. Clarity of speech is definitely an essential one. The tongue requires the freedom to move and reach the palate to sound out letters, words, phrases. If it cannot perform as nature intended then lisping and other disorders can occur. Test yourself – place your tongue tip below your lower anterior teeth, push and hold, now try to talk. Can’t do it right! When restricted the tongue can’t perform as it was intended to do. Swallowing – The tongue assists in swallowing 1200-2000 times per day. Restricted to swallowing via tongue-tie does not allow saliva or food to be chewed completely and swallowed normally. The digestive system needs the salivary enzymes to mix with chewed food for complete digestion. The four to six pounds of pressure on the teeth with an abnormal swallow is called a reverse swallow, or tongue thrust. It can create havoc on the oral cavity. Malocclusion, called open bite, can occur. This includes bi-lateral, unilateral, anterior, molar to molar, anterior-bilateral and several others. Pleasure – Our tongue brings pleasure in different ways. The tongue is the sensory organ that detects sweet, sour, salty, and bitter, thus enhancing our enjoyment in eating and drinking. Vocalization, singMAY 2018

No .3 i

Sharing, Learning & Improving Together. SIMPLIFY YOUR CE JOURNEY WITH THE NEW COMPASS PROFESSIONAL DEVELOPMENT PROGRAM

Needing more guidance and access to better study materials to meet your CE requirements? RDHU and Crest & Oral-B understand how challenging it is to complete the necessary steps. That’s why we’ve teamed up to develop the COMPASS Professional Development Program. I’m so proud to share this new tool that is designed to simplify your goal setting, provide access to study materials and help you implement your new learning in practice. When you join COMPASS, you’ll receive the tools you need to help you reach your goals! Joining COMPASS gives you access to try new products that use the advanced technology and science you’ve just learned about! As a bonus in your kit, you’ll be able to experience the new Crest Pro-Health formula; the only toothpaste with patented stannous ﬂuoride technology to help prevent and protect against dietary acid erosion. Once you brush with this breakthrough formula, you’ll see why toothpaste really does matter! Register on dentalcare.ca to continue to receive VIP access to special product offers and samples for both you and your clients!

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ing, playing musical wind instruments would be impossible without the tongue. On a more serious social note - French kissing and affectionate words to partners would be impossible. Classifications – There are a variety of classifications of tethered oral tissues. These are presented here courtesy of Dr. L. Kotlow from Albany, New York. There are four classifications of tongue-tie. They can be found in the book Please Release Me - The Tethered Oral Tissue (TOT) Puzzle by Patricia Pine, RDH, COM™. 1. Class IV tongue-tie is located at the tip of the tongue and extending half way between the salivary duct and tip of the tongue. 2. Class III tongue-tie is located from the salivary duct half way to the top of the tongue. 3. Class II tongue-tie is located between the back of the salivary duct halfway to the base of the tongue. 4. Class I tongue-tie is located from the base of the tongue, halfway to the salivary duct. Classification does not reflect the severity of the restriction.

MY TONGUE IS TIED – NOW WHAT DO I DO? Schedule an appointment for any age group with a Certified Orofacial Myologist, who provides Myofunctional Therapy (COM™). The COM™ can evaluate tongue and lip ties along with assessing conditions that may be occurring without your knowledge, i.e. swallowing MAY 2018

issues. Some symptoms adults often just brush off, stating, “Oh, I am ok”. Infants and children go with the flow and struggle through life unaware that there is a problem, not knowing there is a remedy called orofacial myology. Living in discomfort or pain is not good for the body as inflammation should be reduced immediately. Certified Orofacial Myologists (COM™) typically work with a multi-disciplinary group of professionals to assist in a smooth transition of a tethered tongue to a tongue with freedom. First and foremost, pre-stretching is required for complete success. Your orofacial myologist will train the tongue to perform specific exercises preand post-release. Once the tongue is free it has no idea what to do with food, speech, swallowing, etc. A dentist who is experienced and knowledgeable with TOTs is essential to provide the frenum release. Currently, the tool of choice is a CO2 laser. In the past, scissors or cauterization were used for frenectomies. Patients who have neck or shoulder tightness or torticollis, will be referred to a chiropractor and/or cranial sacral therapist for non-invasive bodywork. Your chosen orofacial myologist has a network of professionals for your convenience. It’s a team effort for smooth therapy. Your certified orofacial myologist may detect additional oral disorders, which means a comprehensive assessment is needed. Releasing tethered tissue is not the total answer. Re-education of oral and facial muscles is necessary to improve dysfunction and improve physical health.

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FIGURE 1

FIGURE 2

Figure 1: Lip tie – attached tightly to lip Class II. Figure 2: Class III – entire floor of the mouth lifts, short, tight. Copyrighted photos courtesy of Pat Pine, RDH, COM. Do not copy.

May 2017

oralhygiene

OVERLOOKED TETHERED TISSUES

Have you looked in a mirror to check out the frenum under your tongue yet? It just might answer some of your questions.

When the tongue-tie is overlooked in an infant, future total health problems can occur. When a tight frenum is holding that lower jaw, that jaw cannot grow forward. This affects skeletal development and oral facial growth. It decreases oxygen to the brain, hindering normal neurological growth and development. This unusual muscle, also called an organ, controls our future aspects of physical health as an adult. All aspects of the body are connected. It’s a puzzle worth putting together with your therapist. Have you looked in a mirror to check out the frenum under your tongue yet? It just might answer some of your questions. Clearly the tongue can meet the criteria of causing problems in the body. Yes, the tongue should be evaluated for tongue release, at any age. But, the tongue-tie release is not the miracle cure for other possible issues in the body. Ignoring a tongue-tie will cause health issues long term. Those adults may be having many symptoms such as shoulder, neck pain, and headaches while never thinking it could be this frenum under the tongue. They may feel they are too old. That is not the case. Adults are never too to be checked by a COM™!

WHO IS IN CONTROL OF YOUR BODY? The tongue has a range of tasks that control the entire body, within every different body system. It seems that the tongue is controlling our systems. Let’s start there with your tongue, checking for proper function, freedom and mobility. The disorders listed above can be resolved by seeing a Certified Orofacial Myologist (COM™) who specializes in this type of oral therapy to harmonize muscles and identify which muscles of the face, lips, and mouth are not properly functioning. We are connected in so

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many ways. Let’s get back to total health. Ask these questions about your children/grandchildren/yourself: • Do I snore? • Do I stop breathing while sleeping? • Do my neck or shoulder hurt or have pain? • Is my mouth opened during the day? This could even be a small opening. • Do I drool on my pillowcase? • Am I tired during the day? Take naps during the day? • Can my tongue reach my palate when it’s wide open? • Do I clench or grind my teeth? • Do I have speech concerns, lisp? • Do I have frequent headaches? • Do I have acid reflux? • Do I have dry lips? • Do I have swallowing problems? • Do I have stomach aches, bloating, gas, burping, hiccups? • Is the tip of my tongue heart-shaped? These are only a few questions on a long list that will assist in helping you or your child. Check out the websites below for more information.

Research: Please Release Me – The Tethered Oral Tissue (TOT) Puzzle www.musclesinharmony.com Muscles in Harmony www.blog.musclesinharmony.com Benefits of Nose Breathing and Nitric Oxide https://www.healingnaturallybybee.com/ breathing-through-your-nose-is-essential/ Tongue Tie from Confusion to Clarity https://tonguetie.net/breastfeeding/ TOTS – Tethered Oral Tissues https://www.kiddsteeth.com/assets/pdfs/ articles/drkotloworalhealth2015.pdf

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ORAL HYGIENE

PROVIDING PREVENTIVE DENTAL CARE IN THE COMMUNITY FOR PERSONS WITH SPECIAL NEEDS: Closing the Gap Between Mobile and Conventional Dental Clinics in the Community

Josie Costantiello, RDH has 10 years experience working as a Self-Initiated Dental Hygienist and dedicates the majority of her time treating individuals with various Special Needs, through her partnership in the company Community Outreach Mobile Dental and Dental Hygiene Services (COMDH). Josie works as a part time clinical instructor in the Dental Hygiene clinic at Durham College, where she graduated from in 2008, guiding the next generation of Dental Hygienists, in an instructional and mentorship capacity, in regards to their skills and development into future dental hygiene providers, with hopes that some may pursue careers within the Special Needs community. Josie has three family members with Special Needs, ranging from Down’s Syndrome, ASD and a rare genetic intellectual disability. Josie can be contacted through her website: www.comdh.org.

oralhygiene

ou would be hard pressed to find anyone in the dental industry who has said that starting a new mobile dental and/or dental hygiene practice in the community is an easy and simple feat. In fact, from the experiences of my own and other persistent dental hygienists, it is anything but easy and simple. Now, add to the “challenges” of operating a mobile practice with a patient base comprised of individuals with various special needs, factoring in behavioural and often at times logistical challenges, individuals with Autism Spectrum Disorder, Developmental Disabilities, Dual Diagnosis and individuals with severe mental health conditions. Taking all of the above into account, it is quite understandable that for those dental providers who have not had the opportunity to expose themselves to this community group and method of practice, while training in school or during their own clinical work experience, this surely would sound like a recipe for disaster. The good news is, it has not been a disaster and slowly but surely, through the help of several individuals in the dental and special needs communities, systems and pathways have been created in order to better serve these individuals in obtaining access to compassionate, quality preventive dental care in familiar and comfortable surroundings, right in the comfort of their homes/group homes or day programs.

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Let’s take a closer look at what I, and many other dental providers have encountered, as the main challenges for vulnerable persons who have had issues in accessing dental care in Ontario: 1. Lack of Proper/Adequate Provincial Funding: Provincial Government Subsidized Social Services Programs for individuals in the special needs community who are on General Disability Coverage and/or Low Income Social Services Coverage. The Dental Fee Guides associated with these Government Subsidized Programs, which reimburse dental providers for treating individuals who receive Social Services Assistance, provides two main obstacles in allowing this group access to adequate dental care. a. Fees associated with the dental procedures in these Social Services fee guides are extremely low in relation to the Provincial Suggested Dental Fee guides provided by The Provincial Dental Associations (ie: ODA and ODHA) and are so outdated that they have not been updated in almost a decade. While the idea of subsidized funding is understood, the issue is that the fees behind this subsidization are so outdated that, unfortunately, it creates a stressful situation for dental providers who are dedicated to providing more frequent and comprehensive care for this demographic. The level of compensation from these government subsidized MAY 2018

programs is out of touch with the reality of the current economic climate, and so it becomes extremely challenging for dental providers to be willing to accept patients on a regular basis. I personally have encountered many dental offices in the community who either do not accept Government Subsidized Social Assistance Dental Coverage at all, or some that will schedule only one person per month who receives this coverage. Some Government Subsidized Coverage Programs go as far, in the majority of regions in the province, to not even cover any preventive services at all, such as dental scaling, and will only cover dental emergencies, such as extractions and restorations, based on an “approval” basis. There is little to no incentive for dental providers to adequately book their schedules with patients who receive Government Subsidized Dental Coverage as many feel that they “lose money” given the high overhead and fixed expenses dental offices have in order to run their clinics from a long term business standpoint. b. The administrative obstacles present within these Government Subsidized Dental Programs, although improved upon over the last few years, make it difficult to perform routine procedures more frequently on this populated demographic due to the constant necessity for pre-determinations/ “estimates”. Many dental offices have told me that the time it takes out of the dental administrative staff’s schedule to process and follow up with these estimates makes it inevitably “not worth it” from an overhead expense standpoint. 2. Misconception that mobile dental hygiene practices “take away” from dental clinics in the community is the next challenge: Speaking from experience, the present large gap that I have witnessed in accessMAY 2018

ing dental care with the individuals in this demographic in and of itself proves that dental clinics are having difficulties in coordinating access to dental care for these patients and hence, are presently not even treating their dental needs. In terms of the Mobile Dental Hygiene Preventative Service I provide, I not only work directly with dentists who assist in providing examinations, initial screenings and treatment planning for patients, prior to me performing my preventative services, but we also refer these patients, whom the majority have not accessed dental care for several years, to local community dental clinics and simplify the process for these clinics by targeting and treating the main areas of concerns without “tying” them up and

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May 2017

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The immense obstacles in forming a new relationship not only with the future special needs patients, but with their caregivers and/ or group homes, need to be overcome first which can take several hours of patience, and administrative and clinical coordination.

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becoming an economic burden in treating these patients. Dental clinics in the community become how specialty dental clinics are for general dentistry clinics. Special Needs patients are “prepped” and the treatment planned ahead of time before being referred directly to community clinics to continue the prescribed treatment plan.

•

• 3. The immense obstacles in forming a new relationship not only with the future special needs patients, but with their caregivers and/or group homes, need to be overcome first which can take several hours of patience, and administrative and clinical coordination (group homes can house from four to over 75 people under one roof, depending on the size of the home and the types of needs the individuals have). These obstacles include, but are not limited to:

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Gaining the trust of the decision maker of the home to allow for a new “unconventional” service into the home for their residents Obtaining consent for treatment from family members, Substitute Decision Makers and/or Public Guardian and Trustees Collecting detailed medical history information and medication lists Gaining the trust of the individuals through multiple “introductory” or “TLC” appointments with a population group who either fear any new treatment or have a fear of speaking to someone new and then allowing the treatment to take place. Some behavioural challenges make the simplest thing, such as tooth brushing a very large task.

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Oral-B Oscillating-Rotating-Pulsating Power Toothbrush accepted by the ADA.4 *Merriam-Webster online dictionary. Available at: https://www.merriam-webster.com/dictionary/sonic References: 1. Data on ﬁle at P&G Canada. 2. Ccahuana-Vasquez RA. An Eight-Week Clinical Evaluation of an Oscillating-Rotating Power Toothbrush with a Brush Head Utilizing Angled Bristles Compared with a Sonic Toothbrush in the Reduction of Gingivitis and Plaque. J Clin Dent 2015;26:80–85. 3. Klukowska M, Grender J M, Conde E et al. A six-week clinical evaluation of the plaque and gingivitis eﬃcacy of an oscillating-rotating power toothbrush with a novel brush head utilizing angled CrissCross bristles versus a sonic toothbrush. J Clin Dent 2014;25(2):6-12. 4 . Oral Health. Product Spotlight. Oral-B Power Toothbrushes to Receive ADA Seal of Acceptance. Cited: January 2018. Available at: https://www.oralhealthgroup.com/products/oral-b-power-toothbrushes-receive-ada-seal-acceptance/ © 2017 P&G ORAL-22366

From an advocacy standpoint, in an effort to support the elderly and persons of all ages with varying special needs, the Government of Ontario should take a more realistic approach to subsidizing dental care for these individuals.

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oralhygiene

The level of experience required in working with this group cannot be understated. Through my many hours and years working with this demographic I can honestly say that this type of mobile service may not be of benefit for a dental provider to â€œcontractâ€? out. It is imperative that dental providers who wish to become involved in treating this demographic invest time and resources in working with these patients directly, not only on a dental level but, on a volunteer basis in community clinics and group homes to truly get the â€œfeelâ€? for the constant struggles and difficulties in communicating with these individuals and gain valuable experiences in effectively communicating with them in order to perform dental treatment in a worthwhile manner. Further, from an economic standpoint, and based on the current Government

Subsidized Dental Programs, in order to obtain not only critical treatment and personal satisfaction from treating these patients, but also economic satisfaction, it is important that dental providers perform the treatment directly themselves. 4. The next challenge is finding a local dental clinic for the patient to obtain dental radiographs, and any treatment required, nearest to their residence (a clinic that will accept Government Subsidized Dental Coverage). Annual dental radiographs is a strict policy to emphasize to patients, whereby it is constantly communicated to the patient that the initial diagnosis is â€œpreliminaryâ€? and it identifies more obvious â€œproblemsâ€?, and that a definitive diagnosis can only occur with dental radiographs performed at a

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MAY 2018

dental clinic. The ongoing discussion of the importance of dental radiographs is the first step in “bridging” the gap for the patient to obtain more comprehensive dental treatment at local dental clinics. The ongoing encouragement to seek a more “thorough exam with x-rays” is discussed at each visit, once the dentist on our mobile staff has performed their complete exam/screening and formulated a preliminary diagnosis at the home. There is no doubt that the majority of the individuals residing in group homes have either never been to a clinic to see a dentist or go very infrequently, based on clinical findings with experience. It is the “nudge” that mobile dental clinicians give to these individuals or their care givers that will most likely result in a trip to the clinic where they are less likely to go on their own will.

For those dental clinics who do accept Government Subsidized Dental Coverage, mobile clinics can only “add” to their patient base, not subtract from them. From an advocacy standpoint, in an effort to support the elderly and persons of all ages with varying special needs, the Government of Ontario should take a more realis-

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tic approach to subsidizing dental care for these individuals. This includes not only improving upon the compensation levels in the existing government funded programs, to a point where it is in line with annual inflation and is no longer unsustainable economically to treat these patients in larger numbers and higher frequency, but also consider increasing the eligibility age for elderly individuals on the Government Subsidized Disability Program from 65 to at least 70 years of age. A great amount of low income elderly individuals have some form of disability, but due to the age restrictions of the existing Government Subsidized Disability Program, they no longer qualify (the age where many health problems, including oral health, deteriorate at a much faster rate). Simply providing a “tax credit” to “reimburse”

A great amount of

individuals 12 months later, who do not have dental insurance, in order to possibly allow them to obtain emergency and more frequent dental care completely ignores the fact that the vast majority of these people struggle day-to-day to cover the costs of living never mind pay for dental care “upfront” and then get a tax credit 12 months later. As the old saying goes, we as a society are judged on how we treat our most vulnerable. Can our past and current governments really say that they have treated the dental needs of our most vulnerable well and that they have made a concerted effort not to handicap the vast majority of dental providers who wish to provide dental care for the special needs population? The outcries of our veterans and families of persons with disabilities tend to say otherwise.

low income elderly individuals have some form of disability, but due to the age restrictions of the existing Government Subsidized Disability Program, they no longer qualify

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ORAL HYGIENE

5 LIFE SAVING MINUTES: Introducing the North American ‘Check Your Mouth™’ Campaign

Jo-Anne Jones is an international awardwinning speaker, and was named a Dentistry Today CE Leader in 2018 for the eighth consecutive year. While preparing to present her research on HPV-related oropharyngeal cancer to her national association, a family member received a diagnosis of late-stage HPV tonsillar cancer, succumbing to the disease 16 months later. Ms. Jones proudly partners with the Oral Cancer Foundation in conveying the urgent need for changing the way in which we screen for oral cancer to meet the needs of today’s population. She can be reached at via email at jjones@jo-annejones.com or by visiting www.jo-annejones.com MAY 2018

t the time of writing this article, the Check Your Mouth™ campaign is growing exponentially. The North American launch of the public campaign in February of this year has been a long awaited aspiration of the Oral Cancer Foundation and specifically of the founder, Brian Hill, a stage IV oral cancer survivor himself. The emergence of Throat Scope, the world’s first all in one illuminated tongue depressor on the market, would become the ideal tool to facilitate an effective self-examination for the public campaign. The partnership of the Oral Cancer Foundation and Throat Scope supported strongly by the Canadian Dental Hygienists Association and the American Dental Hygienists Association has created an organically driven movement across North America. Why is this campaign so necessary? The key to saving lives is earliest possible discovery of an abnormal finding. When an oral lesion is discovered in the early or localized stage, five-year survival rates are impacted significantly accompanied by an improved quality of life for survivors1 (Table 1). Oral and oropharyngeal cancer are still found at the later stage primarily due to lack of public awareness and the lack of routine opportunistic screening programs being employed.

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The concept of in home self-examination of the head and neck and inside the oral cavity follows other successful models such as ‘Do You Know Your ABCDE’s?’ initiated by the Skin Cancer Foundation. 2 The concept was to educate the public on examining their skin and taking note of any new moles or growths, and any existing growths that undergo change and/ or symptoms. Public awareness and education are the key critical components to drive earlier discovery whether it be melanoma or oral cancer. This by no means detracts from the importance of a regular professional oral cancer screening. It in fact reinforces the importance of it. The incidence of oral and oropharyngeal cancer continues to increase each year. The often optimistically and confounding statistic is the improved five-year survival rate; “the survival number at five years from diagnosis was for many decades about 50%” and presently 57% “so 57% is an improvement over the last ten years”. 3 The cause of this improved rate is not due to increased or improved screening techniques aiding in earlier discovery or medical discoveries leading to superior treatment outcomes. It is directly correlated to the increase in incidence of a different etiologic pathway causing an escalation of oral and oropharyngeal

May 2017

oralhygiene

5 year relative survival by stage and tumour site Stage

Lip

Tongue

Floor of mouth

Early stage or localized (stage 1 or 2)

93%

78%

75%

Locally advanced or regional (stage 3, 4A or 4B)

48%

63%

38%

Metastic (stage 4C)

52%

36%

20%

cancers that react more favorably to treatment modalities resulting in increased survival rates. For the large part, the North American population is unaware of the risk factors the lead towards oral cancer. Historically smoking and alcohol have been the two most well-known etiologic pathways. Many feel that if they are nonsmokers and non-drinkers, they will not possess an inherent risk for oral and/or oropharyngeal cancer. This new pathway and fastest growing profile is caused by a very common virus, the Human Papillomavirus (HPV). HPV is fueling an epidemic of oral and in particular oropharyngeal cancers in a much younger age group. Because of the prevalence of the virus, almost every sexually active person is exposed to the cancer-causing strains of the virus as they begin to engage in sexual activity. The greater the number of partners, the greater the risk, however it may be the first sexual partner that initiates contact with a high-risk strain. It is important to note that there are over 200 strains of the Human papillomavirus of which nine have been identified to be oncogenic or cancer causing. HPV-16, a high-risk

TABLE 1

oralhygiene

strain, accounts for the vast majority of oral and oropharyngeal HPV-related cancers. It is through a persistent infection with a highrisk strain, such as HPV-16 that presents an increased risk for a transformation to malignancy. For most, the virus like the common cold, is dealt with and cleared by a functioning immune system. â€œThere is no recommended clinical indication for oral human papillomavirus screening to evaluate the risk of developing oropharyngeal cancer.â€?3 To this point, there is the possibility of elevating unnecessary anxiety through more testing

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over something that will likely resolve on its own in the vast majority of individuals. The HPV etiologic pathway does present its challenges clinically. Typically occurring in posterior anatomical areas including the lingual and palatal tonsillar areas, posterior base of the tongue, soft palate and oropharyngeal area presenting a challenge in gaining visual access. A dedicated light source and magnification through the use of loupes are essential tools to visually evaluate soft tissues of the oral cavity and accessible oropharyngeal areas. Equally important is the employment of tactile palpation wherever anatomically possible for all extraoral and intraoral anatomical areas. We are mandated by our professional Standards of Practice to perform an extraoral and intraoral soft tissue examination which includes an oral cancer screening. The oral cancer screening examination is not an option; it is our responsibility. Furthermore, educating our clients on the importance of doing a self-examination at home and initiating a self-referral is a supportive and strong step toward earlier discovery (Fig. 1). Through education

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provided on the Check Your Mouth™ website, our clients will have an elevated awareness of ‘what to look for’ and ‘what shouldn’t be ignored’ reinforcing the need for self-referral and examination by a dental professional (Fig. 2). This would then eliminate the long time period between regularly scheduled professional care and the opportunity for assessment of an abnormal finding. The clear message of the Check Your Mouth™ campaign is the selfexamination of the face, neck and inside the mouth on a monthly basis. It is through this familiarity that a new finding will be most readily recognizable. A persistent finding, being anything that does not resolve within two weeks, should be further examined by a dental professional. The Check Your Mouth™ website provides an educational video illustrating a step by step self-examination of the face, neck and inside the oral cavity and visually accessible areas of the oropharynx. An overview of what to look for complemented by a visual gallery of normal vs. abnormal findings is included on the site. The often subtle, life-saving symptoms are outlined along with risk factors. The recommended tools are made available for purchase through the website (Figs. 3 & 4). Professional postcards to provide to the dental hygiene client are available through the Oral Cancer Foundation store (Fig. 5) (http://www.ocfstore.org/ check_your_ mouth _ info_ postcard_p/cym-250.htm).

MAY 2018

FIGURE 1

FIGURE 2

The clear message of the Check Your Mouth™ campaign is the self-examination of the face, neck and FIGURE 3

inside the mouth on a monthly basis.

www.oralhealthgroup.com

May 2017

oralhygiene

FIGURE 5

FIGURE 4

The Check Your Mouth™ campaign provides our professional community with a tangible resource to make positive inroads on earlier discovery of oral and oropharyngeal cancer.

The information on the card provided at the dental hygiene recare appointment will direct the client to the website for further information. Additional information on oral and oropharyngeal cancer may also be found on the Oral Cancer Foundation’s comprehensive website www.oralcancer.org. Client educational materials and practice resources are available through the Oral Cancer Foundation, the CDHA professional and public site, Dental Hygiene Canada (resource listing at the end of the handout). Often we feel powerless to positively impact the course of an abnormal finding. The Check Your Mouth™ campaign provides our professional community with a tan-

gible resource to make positive inroads on earlier discovery of oral and oropharyngeal cancer. The support of our professional associations and each dental hygienist across our country will be the cornerstone of the success of this campaign. Thanking you in advance for your commitment. Disclosure: Jo-Anne Jones is a contributor to the project management team for the Check Your Mouth™ campaign. Jo-Anne serves as an advisor to Throat Scope ® and is involved in the North American launch of Throat Scope ® into the dental community. There was no financial compensation received for writing this article.

References:

1. http://www.cancer.ca/en/cancer-information/cancer-type/oral/prognosis-andsurvival/survival-statistics/?region=on# 2. https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/do-you-know-your-abides 3. http://jada.ada.org/article/S0002-8177(17)30750-X/pdf

Educational Resources:

Check Your Mouth™ Professional Postcards: http://www.ocfstore.org/check_your_ mouth_info_postcard_p/cym-250.htm Oral Cancer Foundation Info Sheets: www.oralcancerfoundation.org (Home>>Resources>>Screening Event Downloads; Oral Cancer Facts & HPV Sheet) CDHA Professional and Public Resources: Online course and booklet for download: www.cdha.ca/oralcancer Public information site and video: www.dentalhygienecanada.ca/oralcancer Early Detection Flyer: www.dentalhygienecanada.ca/pdfs/DHCanada/OralCancerEarlyDetectionFlyer.pdf Oral Cancer Fact Sheet: http://www.dentalhygienecanada.ca/pdfs/education/OCS_ FactSheet_2015.pdf

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ORAL HYGIENE

WHAT YOUR EARS MAY TELL US ABOUT YOUR HEALTH

Irene Iancu, BSc, RDH, CTDP Irene Iancu has worked in various specialties including Paedo, Perio, General Practice and Orthodontics. Her goal in her current holistic practice is prevention and maintaining an optimal mind, mouth and body. Irene connects the systemic effects of oral conditions to her clients, while making a change for overall health and wellness. As a Peer and Quality Assurance Mentor contracted by the CDHO, a Clinical and Theoretical Dental Hygiene instructor at Oxford College, and a practicing dental hygienist in Toronto; Irene shares her passion for education with us today in the hopes we can change the lives of our clients and their loved ones.

oralhygiene

e are living in a systemically compromised world. As the prevalence of physical illness increases through the decades, we, as dental hygienists, are finding ourselves in a position to help with early evaluation. As RDH are competent in so many aspects of client care, we are constantly putting the pieces of the proverbial puzzle together, attempting to connect systemic health to oral health findings – linking the association of pharmacological effects, and trying our very best to help clients manage their oral health while standing witness to their systemic health issues. In dental hygiene school, we were taught to seek communication with other health care professionals to help our clients get the best care possible and somewhere from then to now, that message may have faded. We are allied health care professionals, distinct from medicine and nursing. We are part of a broad group of health professionals who use scientific principals and evidence- based practice for the diagnosis, evaluation and treatment of acute and chronic diseases; we promote disease prevention and wellness for optimum health and apply administration and management skills to support health care systems in a variety of settings. (Asso-

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ciation of school of allied health professions, 2018) The constantly updating list of allied health care professionals consists of nearly 48 professions. The precise titles, roles and requisites of allied health professionals may vary from country to country, however, there is honour to be considered a partner with these professionals which include but are not limited to: • • • • • • • • • • • • • • •

Art therapist/art psychotherapist Athletic trainer Dental hygienist Dietitian/nutritionist Exercise physiologist Lactation consultant Music therapist Occupational therapist Operating department practitioner Physical therapist/physiotherapist Physician Assistant Public health epidemiologist Rehabilitation counselor Renal dialysis technologist[2] Respiratory therapist

(Wikipedia contributors, 2018)

We have known for decades that dentistry and medicine have not always been aligned, with often conflicting opinions of what health looks like, and how it pertains to dentistry. As a dental hygienist celebrating 11 years in the profession, I have had conversations with family physicians that have left me

MAY 2018

shocked – questioning why blood pressure and glucose levels are important for “just a cleaning”. We know that it is not within our scope of practice to diagnose systemic disease, however, we can express concerns for our clinical findings during assessment and encourage our clients to seek medical evaluation as we are health care professionals. Our bodies are complex systems that have a way of demonstrating on the outside what may be brewing on the inside. The connection between your ears and heart may be a stronger connection than we thought. In 1973, an American physician, Dr. Sonders T. Frank, described the presence of a suspicious line on multiple patient’s ears. It was a diagonal crease in the earlobe that started from the Tragus to the end

of the Auricle, in the angle of about 45 degrees in varying depths (Nazzal S, 2017). Frank’s sign was described as a predictor of future coronary heart disease and peripheral vascular disease. Over the years, various institutions have taken Dr. Frank’s discovery and studied its validity within diagnostic medicine. Stanford Medicine’s publication July 2015 outlined a grading of the sign to describe severity from Grade 1-3, bilateral or unilateral, and gave some insight on the pathophysiology of the sign based on findings within their studies (Stanford Medicine, 2015). The American Journal of Medicine published a paper and concluded that “Frank’s sign could predict ischemic cerebrovascular events. Patients with classical cardiovascular risk factors had Frank’s

Photo courtesty of George Griffing, MD, The New England Journal of Medicine

MAY 2018

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May 2017

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sign at a higher frequency” (Nazzal, Hijazi, Khalila, & Blum, 2017). The study consisted of 241 consecutive patients who were hospitalized for an acute stroke; 153 patients with transient ischemic attack and 88 with cerebrovascular accident. Frank’s sign was tested in both ears, and clinical data was gathered including age, gender, type 2 diabetes and hypertension. Of those patients, 190 (78.8%) had Frank’s sign present. They also mentioned that 115/241 had type 2 diabetes. Frank’s sign was present in 103 of those patients (87%). This correlation between Frank’s sign and diabetes is still being further investigated (Nazzal, Hijazi, Khalila, & Blum, 2017). With this knowledge comes a responsibility to our clients chairside should we encounter this diagnostic sign. As we continue with ADPIE, this finding could assist us in better understanding other assessment findings like bleeding, tissue response and poor-healing (Anderson & Hamm, 2012). Continued on page 44.

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MAY 2018

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ORAL HYGIENE

STRATEGIC SYSTEMS FOR A SUCCESSFUL PRACTICE GETTING YOUR DUCKS IN A ROW Dynamic Teams – Attitudes and Platitudes:

Lois Banta is CEO, President and Founder of Banta Consulting, Inc., a company that specializes in all aspects of dental practice management. She also owns and is CEO of The Speaking Consulting Network (www. speakingconsultingnetwork. com). Lois has over 40 years of dental experience and consults and speaks nationwide. To contact Lois for a personal consultation or to invite Lois to speak to your organization; Office: 816/8472055, Address: 33010 NE Pink Hill Rd, Grain Valley, MO 64029, Email: lois@bantaconsulting.com or check out her website: www.bantaconsulting.com.

MAY 2018

kay, you have a dental practice, you have all the best equipment, a great computer system, a beautiful building, and all the protocols in place. Now what? You need a dynamic dental team to get you to the next level. Have you ever worked with a team member who had a negative attitude? Negative attitudes affect all areas of your practice, especially when it comes to collections and financial arrangements. One reason a negative environment can exist is due to a lack of systems. If there aren’t clear-cut job descriptions and duties, your dental team will lose focus and not be as prepared when faced with tough situations. When policies and procedures are not consistently followed, frustrations set in. There are several types of attitudes that will affect your systems negatively: • The naysayer: ”That will never work here.” “We can’t do that.” ”Our patients will never go for that.” “Our patients have never paid at the time of service.” • The complainer: ”Our patients never pay what they’re supposed to.” ”Doctor XYZ is always doing treatment without financial arrangements.” ”You always file these EOBs in the wrong place.” • The martyr: ”That’s okay, I’ll send statements, I always end up doing it anyway.” ”I’ll put the supplies away, otherwise it will

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never get done.” “I don’t mind taking out the trash, I’m the only one who does it anyway.” The most effective way to turn around a negative attitude is: • Walk your talk. Presenting a positive environment in the office starts with the owner. The old saying “positive attitudes are contagious” is so true. When the doctor presents a positive environment and attitude it infects the entire team. • Address negativity immediately. Gossiping is never healthy and should be addressed first in the employee manual, and next with the individual personally. Issues should be addressed early so there are not opportunities for them to “fester”. • Reward good behavior, publicly and privately (depending on the team member’s personality style). There are an equal number of attitudes that will affect a practice positively: • The team player: ”To ease your day, I will confirm appointments for you.” ”Which patients need special conversations about FA’s today?” ”I’d be happy to escort the patient up to you personally.” Let’s see, I say “Lois is going to get a receipt for you, right?” • Random acts of kindness:

May 2017

oralhygiene

To create the best team, strive for personalities who would work well together. One way to achieve this is to do a DiSC profile with each team member. 1) Post-it notes with a positive message to the individual who acted unselfishly 2) A sincere smile 3) When you are finished with your task, help someone else out without being asked • Positive reinforcement: Nothing is more rewarding than catching a team member doing something great. Make a positive statement to the team member when they were selfless or acted on behalf of someone else. This reinforces more positive behavior. The number one reason a staff member leaves is due to feeling unappreciated or feeling overworked. Remember team members, it’s a two-way street. Your boss needs positive reinforcement too. To create the best team, strive for personalities who would work well together. One way to achieve this is to do a DiSC profile with each team member. This isn’t a test you can get wrong. In fact, the DiSC profile can be a wonderful tool to assess your patient’s personalities as well. This is an especially helpful tool to identify which person fits the financial coordinator best or to preidentify possible challenges some patients may have with financial arrangements. When you identify someone’s personality trait, you

oralhygiene

have the opportunity to prepare in advance. For example, a patient who wants written guidelines for financial arrangements would have a “C” cautious, correct, perfectionist detail oriented listening style. The four areas of the DiSC profile are: D: Dominant, Direct i: Influencing S: Steadfast C: Cautious, Correct, Conscientious The “D” personality has a tendency to have a very strong personality. They are results oriented and cut to the chase. Every office needs a “D” person because they get things done. However, this may not be the person to handle small details. Sometimes this personality can be perceived as abrasive, which wouldn’t work well with sensitive issues, such as financial arrangements. The “i” personality is usually a very positive, enthusiastic glass is half-full personality. This is a great person to have at the front desk, especially when scheduling treatments. This personality is usually great with patients who need a little convincing to do their needed dental treatment. Attention to detail is usually a struggle for this in-

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dividual and they tend to be slightly disorganized. It would be important to have written guidelines for tracking outstanding insurance claims, making collection calls, etc. “S” personalities have great attention to detail and will be extremely thorough. They are very likable and tend to not want to rock the boat. Confrontation is difficult for this individual. This personality style would be very effective as a dental assistant because of the high empathy for the patient. Handling conflict is usually a challenge with this personality so role-playing how to handle a conflict would be helpful. For instance, the patient may say, “I’m not sure I can afford this crown. Can I make payments?” Role-playing would give an advanced opportunity to plan so there are no awkward moments. “C” personalities are the most change resistant. They are perfectionists and highly analytical. These individuals are toughest on themselves and therefore are quite resistant to change. Researching claims, sending statements and all task-related jobs are easy for this type of individual because they plan ahead. However, when faced with change, like asking for payment at the time of service when

MAY 2018

This personality profile can help you understand each other and create an atmosphere for improved communication with patients.

oralhygiene

you used to bill everyone, would be a challenge without a written plan. Note: Any one of these personality styles can handle financial collection and responsibilities if they can recognize their typical personality style and make adjustments to accommodate. Also, your bottom line improves immediately when all parties participate. The first step is to establish written systems. The second step is to have great communications - recognize where you fall in the DiSC profile and learn to adapt. The DiSC profile is not meant to “pigeon hole” you into a specific personality. All of us have some aspect of each DiSC in them, but there is ultimately one that is more prevalent. Using the DiSC profile can help a dental practice get on the right track with the best direction. This personality profile can help you understand each other and create an atmosphere for improved communication with patients. Statistics have proven your bottom line improves greatly when all systems are working and there is good communication. I always have dental teams take this profile test when I consult in their practice, along with filling out a confidential questionnaire. This helps me identify whether or not a team member is in the correct position for their personality, such as financial administrator or scheduling coordinator. When relating to your patients I suggest devising a quick assessment plan, using the DiSC profile, to help you identify the patient’s personality. These are the patient’s hot buttons, what makes them decide to do, or not to do a treatment and how

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they intend to pay their bill. The motivators are pain, fear, money and time. If you were able to assess these “hot buttons” in advance you would be able to help your patient accept the appropriate treatment in his/her best interest or method of payment they will choose to use. For example, the patient expresses concern about the cost of treatment by saying, “That sounds like an awful lot of money, can I make monthly payments? Can you pre-estimate that?” Their hot button is money and they need more information. They would most likely be a “C” in the DiSC profile. Many offices use the DiSC profile to determine how and where a team member fits best in the office. Additionally, a written job description will take the guesswork out of who is responsible for what job in the office. This job description should be included as part of the employee manual. In addition to that, a clear list of job duties for each position should be placed in writing. This eliminates much of the confusion that happens in a dental practice as it relates to responsibilities of various team members. A team can only take ownership when there are clearly written guidelines. To sum it up, understanding the different types of personalities and how they relate to each other allows you to communicate more effectively. Treat others as you would want to be treated. How you incorporate these various principles can give your practice unlimited potential and improve your bottom line. The DiSC profile can be obtained by calling Banta Consulting, Inc. at 816-847-2055. MAY 2018

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8.5% of Canadians 20 years or older are living with a form cardiovascular disease. One person every seven minutes dies of heart attack or stroke. Cardiovascular disease is the second leading cause of death in Canada and the leading cause of hospitalization. (Government of Canada, 2017) Together with science, we can help reduce those numbers and keep our loved ones and clients healthy.

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References Anderson, K., & Hamm, R. L. (2012, March 24). NCBI. Retrieved from PubMed: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC4495737/ Association of school of allied health professions. (2018). What is Allied Health? Retrieved from ASAHP: http://www.asahp.org/what-is/ Government of Canada. (2017, July 18). Government of Canada. Retrieved from Canada.ca: https://www. canada.ca/en/public-health/services/publications/ diseases-conditions/heart-disease-canada-factsheet.html#fn2 Nazzal S, H. B. (2017, Apr 29). NCBI. Retrieved from PubMed: https://www.ncbi.nlm.nih.gov/ pubmed/28460854 Nazzal, S., Hijazi, B., Khalila, L., & Blum, A. (2017, November ). Diagonal Earlobe Crease (Frankâ€™s Sign): A Predictor of Cerebral Vascular Events. The American Journal of Medicine, 130(11), 1324.e5 . Stanford Medicine. (2015, July 2). Stanford Medicine. Retrieved from Stanford Medicine: https://stanfordmedicine25.stanford.edu/blog/archive/2015/what-isthe-name-of-this-sign.html Wikipedia contributors. (2018, March 16). â€œAllied health professionsâ€?. (T. F. Wikipedia, Producer, & Revision history statistics) Retrieved from Wikipedia: https://en.wikipedia.org/w/index.php?title=Allied_ health_professions&oldid=830736348

Photo credit:

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Franks Sign (link #2) Photo courtesty of George Griffing, MD, The New England Journal of Medicine Reprinted with permission. Oh Canada. Spring Issue 2018.

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oralhygiene

www.oralhealthgroup.com

MAY 2018

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CAREERS

HYGIENISTS

NORTH MANITOBA HYGIENISTS NEEDED Dental office in north Manitoba is looking for two full time dental hygienists. Accommodation is available. Come and join our friendly team you can make 75k to 100k guaranteed per year. To apply email to Chris.p1933@ yahoo.com PRACTICES & OFFICES

NW CALGARY, AB A previous specialist office space located in a high demand business centre with various medical professions in NW Calgary. This area is surrounded by many General Dentists to build a strong referral base. I am looking to share office space and will consider additional options for dental specialist (Oral Surgeon, Periodontist, etc.) Please contact me to discuss further abdentist75@gmail.com.

ENDODONTIC PRACTICE Well established endodontic practice for sale in southwestern Ontario. Flexible transition. Excellent opportunity. Email: endosale@outlook.com ESTABLISHED PRACTICE FOR SALE – WOODBRIDGE, ONTARIO Stunning, modern, recently renovated, 6 Operatory Practice! Great location, located in a Shoppers Drug Mart Plaza! Plenty of free parking! For further inquiries please contact: info@dentalacquisitions.ca

ST. JOHN’S, NL 3 ops dental office established 19 years in St John’s, NL with excellent staff and location in medical centre close to university and hospitals. Long lease, 9-5 four and half days a week, high net 2000 active patients and 50 plus new patients/month. Ideal for one dentist or iDentist. dentistpan@gmail.com, 226-348-0606

THUNDER BAY, ON Established Periodontal Practice For Sale. Flexible transition. For more information please email: pockets@tbaytel.net

THORNHILL/MARKHAM AREA, ON Forced to move? Want to keep your patients? Free rent. Call 416 569 8030 to discuss or email:info@dentistryinthornhill.ca

CRANBROOK, BC

Hygienist required for busy, patient oriented, practice located in the outdoor mecca of the East Kootenays, in Cranbrook, BC. Must be willing to share extended hours. Great opportunity in a great community with an exceptional team. All equipment recently updated. Excellent remuneration available. Apply at CranbrookDentist.ca

ASSOCIATESHIPS

CALGARY, AB Progressive Calgary dental office is seeking an associate with a minimum of 1 to 2 years of dental experience. We own several practices in the Alberta area and are continuing to grow. We are in need of an associate that knows how to provide comprehensive and compassionate care to all of our patients. If you are looking for a place to call home and a great team to work with, please forward us a copy of your resume to: hr@peakdentalgroup.com

TORONTO, ON ASSOCIATESHIPS

ONTARIO

Well established, growing Ontario dental group is seeking experienced, general dentists who are proficient in the areas of: Oral surgery, Periodontal surgery, Endodontics and Implant surgery, to join our team. If you have these qualifications and would like to apply, please send your CV to gail@karavosgroup.com

oralhygiene

BURLINGTON, ON FULL TIME ASSOCIATE to take over well established family practice for a retiring dentist. Ideal candidate will be highly motivated, dynamic, with excellent interpersonal skills and experienced in general dentistry. Future buy-in opportunity will be offered to the right candidate. Please email resume to DentalLifeBurlington@gmail.com

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Busy downtown family dental clinic is looking for a General Dentist, Periodontist and Orthodontist. Please email your resume to davidkourosh@hotmail.com

BROCKVILLE, ON Associate needed in a busy modern dental practice located in the beautiful 1000 islands. Please send resumes to: drvijaybhatt@gmail.com MAY 2018

ASSOCIATESHIPS

TORONTO, ON ORAL SURGERY ASSOCIATE Full-scope oral surgery practice has an immediate need for a fulltime associate. May lead to possible partnership opportunity. This high-volume multi-doctor practice with mid- and downtown GTA locations has a well-established referral base and potential hospital availability. Onsite CBCT/digital x-rays. The position requires a Board-Certified or Board-Eligible oral and maxillofacial surgeon who has ambition! Email: admin@metropolitanoms.com KANATA (WEST END OF OTTAWA), ON Looking for an enthusiastic, motivated, team driven associate to work in the West end of Ottawa, in a full time family practice of 25 years offering all comprehensive dental care. Position does include Evenings and Saturdays. New Grads Welcomed!! Please email your resume to: angmur11@hotmail.com

EAST YORK (DON MILLS AND EGLINTON AREA) – TORONTO, ON

PART TIME ORTHODONTIST Well established general practice seeking a Part-Time Associate Orthodontist to join our team. One day per week required. Candidate must possess excellent communication and treatment planning skills; invisalign experience is an asset. E-mail: kaplans@rogers.com

WILBERFORCE, ON Full time associate required with a minimum of 3 years of experience. Experience in hospital dentistry and dental management of medically compromised patients. Please e-mail: Kdadelahi1@yahoo.com

ROBLIN, MB Work, Live & Play in Roblin, Manitoba! Full Time Dental Associate required for an established dental office. You will be busy from day one! Exceptional remuneration and accommodation provided. Great staff, modern equipment and small town charm. Email your resume in confidence to info@klerdental.ca

AJAX, ON

ENDODONTIST ASSOCIATE NEEDED for established Endo office. Experience preferred however new grads welcome to apply. Excellent opportunity to grow in an expanding community. Please send resumes to drmartinkatzman@rogers.com

NORTH MANITOBA Full time or part time dentist associate in north Manitoba. Good income can be made. Up to 50% plus accomodation. Email: alln1963@yahoo.com

REGINA, SK Seeking motivated and dynamic Associate for long-term, full-time position in a growing, modern and well-appointed clinic. Paid on PRODUCTION! New grads welcome, mentoring available. Contact: admin@courtsidedental.ca

TORONTO WEST, ON

Large, modern dental practice in the heart of Bloor West Village is looking for a DENTAL ASSOCIATE. Applicants should have some Canadian experience. Prefer Russian/Ukrainian language. E-mail: wzigan@gmail.com

DURHAM REGION, ON

Seeking experienced part time associate for busy group practice. 40 minute commute from Toronto. Please send resume to: eastgtadentist@gmail.com

We are looking for a highly motivated associate to join our team of experienced dental professionals and mentors. We have a newly renovated practice with a large patient base. We are digital, paperless and we have our own in house lab. Interested candidates please submit their resumes to linda@ottawawestdental.ca

FORT MCMURRAY, AB Awesome opportunity for substantial extra income. Consolidate your practice and come join us for a few days or weeks a month. Busy mall practice in Fort McMurray, AB. Accommodations and vehicle provided. Call Bob at (780) 940-7251.

GTA AND SURROUNDING AREAS, ON Associate opportunities available across the GTA and surrounding areas. E-mail: yourdentaldream@gmail.com

OTTAWA, ON Full Time Associate Opportunity Looking for a highly productive, motivated individual to take over for a retiring dentist. We have a modern downtown practice with a large patient base. Don’t miss out on this opportunity! Incentive program available to highly productive individuals. Email in confidence to book an interview in person or by phone. annburkeVP@gmail.com

NORTH BAY, ON

RED DEER, AB Busy General Dental practice in great location with large patient base and New Patient flow in Red Deer Alberta, is seeking an Associate to join our dental family. Successful candidate will take over patient load of 2 existing Associates (back to school for specialty). Potential monthly production is well over $120K. Ideal candidate must be a great communicator who possesses strong clinical skills and great patient care. We provide outstanding management to help you succeed. Looking for long term commitment to our dental family. Please call 403-470-8888 or email carol@imagedental.ca MAY 2018

OTTAWA, ON

SEEKING COMPASSIONATE FULL-TIME CLINIC DENTIST TO JOIN OUR PUBLIC HEALTH UNIT TO WORK WITH LOW INCOME CHILDREN AND ADOLESCENTS! The North Bay Parry Sound District Health Unit, located in North Bay, Ontario is opening a brand new, state of the art oral health clinic for marginalized children and adults who face challenges in accessing dental services in our district. The Health Unit currently provides dental care for kids and teens 17 years of age or younger through the Healthy Smiles Ontario program. If you would like to contribute to the Health Unit’s vision of “A healthy life for everyone in our communities”, please visit our website: www. myhealthunit.ca for more information. We offer competitive wages, benefits and a defined benefit pension plan. Please e-mail: human.resources@healthunit.ca

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ASSOCIATESHIPS NORTH YORK AND MISSISSAUGA, ON

THUNDER BAY, ON

LESS THAN 1 HR EAST OF REGINA, SK

Full Time associate wanted between North York and Mississauga locations. An excellent grasp of the English language and good communication skills are important. Proficiency in extractions, endo and crown and bridge desirable. We are looking for someone with an outgoing and enthusiastic personality and is a proactive team player. We look forward from hearing from you. E-mail: resume.dental@rogers.com

Buy-in opportunity. Busy, comprehensive family/orthodontic two-clinic practice in beautiful, scenic Thunder Bay. Remuneration 45% with minimum guarantee. IV sedation, implants and CBCT, in-office CAD/CAM crowns, RCT. Who wouldn’t love the opportunity to work with a CBCT and CAD/ CAM system? Mentorship provided. Send resume with composite photo and references to drmao@abadental.ca

Full time Associate needed for a busy office less than 1 hour east of Regina, SK

PETERBOROUGH/ KAWARTHA AREA, ON

GROW YOUR OWN SUCCESSFUL DENTAL PRACTICE – OTTAWA

FULL TIME ASSOCIATESHIP Full-Time Associates in busy Peterborough and Kawartha area offices. Guarantee Minimum Income. Commutable from GTA but will help with relocation if needed. Paperless charting, digital x-rays, modern facility. Optical scanning. Fewer than 1% patients under OW/ODSP. Owner dedicated to mentor new associates. Experience an asset but not essential. Email: Kawartha-PeterboroughDentist@outlook.com

FULL-TIME ASSOCIATE

Join our large client-oriented multidisciplinary group dental centre. Build your practice through referral and a generous share of ambient new patient flow. We’ll supply superb support staff, state-of-the-art equipment, and committed colleagues. We’re located in a regional retail plaza and we offer extended hours. If you’re an experienced dentist or new graduate who wants to love where you work, contact us today! business@adcottawa.com

Full schedule from day one. Guaranteed daily pay. More amazing incentives to the right individual. New grads welcome and mentoring is available! Our associates make on average between 250-400k a year! Email resume to: aspiredentalcorp@gmail.com

LONDON, ON Established Family Practice in beautiful London, ON has an immediate need for an experienced full time associate. This is a great opportunity to put your exceptional clinical skills to work in an environment supported by a dedicated team of professionals. The ideal candidate will be proficient in all aspects of Dentistry and possess the superior communication skills necessary to foster excellent patient rapport. If this scenario appeals to your long term career goals please forward your CV to kim@pellarkdental.com

PICKERING, ON Looking for a highly motivated, friendly associate to join our team in a well-established, multi-chair group practice that’s been serving Durham Region for more than 36 years. We are a professionally managed office with a strong hygiene program, a multi-generational loyal client base, and a strong new patient flow. We offer an excellent opportunity for full time professional development in a friendly, relaxed environment with our wonderful dental team. For consideration please email resume to dentist8office@gmail.com

GTA – TORONTO, ON PRIMARY DENTIST OPPORTUNITY Do you want to be fully booked, extremely busy, and productive? Step into the shoes and caseload of our senior retiring dentist as part of a multi-dentist high-end practice. Present cases using our experienced treatment coordinators and do the dentistry you always dreamed of with the support of a top end team. Ideal candidates must have ability and desire to produce average of $75k per month and possess an advanced skill set. Contact Ann in confidence annburkevp@gmail.com

oralhygiene

www.oralhealthgroup.com

MAY 2018

ASSOCIATESHIPS

ALBERTA

OTTAWA, ON

ORAL & MAXILLOFACIAL SURGEON Well-established oral surgery practice centrally located in our nation’s capital seeking an oral & maxillofacial surgeon for an associate position interested in a transitional purchase. Also willing to sell outright and stay on as an associate. Compassion, excellent communication skills and a strong ethical conviction will ensure a good fit with our vision. The candidate must be eligible for licensure to practice as a specialist in oral and maxillofacial surgery in Ontario, including Fellowship in the Royal College of Dentists of Canada (RCDC). Please forward CV and inquiries to: manager@drwwayne.com

Full time pediatric dentistry associate at a Pediatric/Orthodontic Practice in Alberta, Canada. The practice has the following features: Central location, Great population/specialist ratio, on site GA/Sedation theatre, 3D imaging, Expected minimum of 200 new patients a month, Possibility of buying the pediatric side of the practice, expansion potential, income potential is over 600k. Please call (780)716-4469 or email: saleh1997@hotmail.com

ETOBICOKE & DOWNSVIEW, ON

TRENTON-BELLEVILLE, ON Well established patient base, supported by a talented team of professionals is seeking a passionate full time associate/partner to join our team, that thrives on patient experience & excellence, with potential partnership. This ideal candidate must be enthusiastic, dynamic, conscientious, work well in a team environment and has 2+ years experience. Please forward resume to dentistsopportunity@gmail.com

VICTORIA, BC

PAEDIATRIC ASSOCIATE DENTIST Great opportunity of mentorship & partnership. Beautiful new office. We offer IV, GA, nitrous & conscious sedation. Ideal opportunity for someone seeking balanced lifestyle. Email: vpdc@outlook.com

TORONTO, ON

WANTED: Well-rounded Pediatric Dentist for established and growing pediatric dental clinics in Toronto, Canada. Offering 50% compensation, additional signing bonus and mentor-ship from experienced Pediatric Dentists. If you are looking for a modern clinic with an extraordinary culture that values patient care and having FUN at work then please email your resume and cover letter to info.dentistry4kids@gmail.com

STRATFORD, ON Very Busy Office Looking for an Associate. FT/PT associate opportunity available in a very busy, advanced office (cbct, cerec, implants, paperless…). Candidate should be motivated and patient-care focused to join our excellent, skilled and friendly team. Email: dentalgroupswo@gmail.com MAY 2018

MISSISSAUGA, ON PART TIME ORTHODONTIC ASSOCIATE. Hometown Orthodontics is recruiting world class talent in a PartTime Orthodontic Associate beginning July 2018. We create beautiful smiles. We build lasting relationships. We make a difference. We are not saving lives, but we are certainly changing lives. If you are ready to be part of a game changing team, come join us. Associates must have a specialty licence in Orthodontics. New Graduates welcome. Please send resume to: drvirdee@hometownortho.ca

DEEP RIVER/PEMBROKE: ROCKSTAR ASSOCIATE REQUIRED

We are looking for a full time associate to work full time between both our Deep River and Pembroke locations. Well established and highly productive offices. 50% associate fee. Apply with resume to: amyfudge16@gmail.com

PT associates required for established dental offices in Etobicoke and Downsview. The ideal candidate should be well rounded in general dentistry and have excellent communication skills. Minimum of 2 years experience required. Resumes can be sent to: ddassociate66@gmail.com

KITCHENER, ON Part time associate who is able to perform wisdom teeth extractions and molar endos. E-mail: parnanzone@yahoo.com

LLOYDMINSTER, AB Modern and nicely equipped clinic with a well established and growing patient base seeking a full-time, long-term, experienced Associate. Paid on PRODUCTION! Contact: admin@oriondentalgroup.ca

BRAMPTON, ON

Dental associate needed who is proficient in all aspects of general dentistry. 4 days/week – Monday, Wednesday, Friday, Saturday. Must be fluent in Punjabi or Hindi. E-mail: mskalra1@hotmail.com

CAMBRIDGE, ON Associate needed for established, growing practices. Monday 12-8 and One Saturday a month 8-2 . Please apply with resume to saginaw.dental@hotmail.com

DOWNTOWN TORONTO, ON PT/FT ASSOCIATE Our modern downtown offices are looking for an associate to join our growing group practice. Paperless and fully digital with access to the latest technology. Excellent communication skills and min 1 yr experience required. Endodontist and Periodontist also wanted. Please forward your CV to: Cara.dental1@gmail.com

www.oralhealthgroup.com

OSHAWA AND COURTICE, ON PERIODONTIST WANTED We are looking for a periodontist every Monday (9-8) at our Oshawa Office and every Tuesdays (9-5) at our Courtice Office. Patient care is our focus, we provide all dental services. We have a full Hygiene program to support, candidate must be comfortable providing perio surgeries. We are looking for the right candidate for this permanent position, a new grad will be considered, the position is immediate. www.oshawacd.com

oralhygiene

ASSOCIATESHIPS

OTTAWA, ON

PERIODONTIST NEEDED

Our state of the art periodontal practice is looking for a full time associate. We offer a true teaching/mentorship environment with an opportunity to buy into the practice. All inquiries are confidential. Please forward your CV and cover letter to: ottawaperiodontist@gmail.com

CRANBROOK, BC Associate required for busy, patient oriented, family dental practice in the beautiful outdoor paradise of Cranbrook, BC. Ideal candidate must be a great communicator, make patients a priority and be comfortable in all aspects of dentistry. Applicants must be self-motivated, and willing to share extended hours. Awesome opportunity in an awesome community, with an exceptional team. All equipment has been recently updated. Specialists looking to relocate are welcome! Check us out and apply at CranbrookDentist.ca

BRANDON, MB FULL TIME ASSOCIATE POSITION Busy Modern practice in Brandon looking for a full-time associate. A positive and progressive attitude are a must! Our practice is focused on not only providing exceptional care but a great patient experience as well. If this sounds like a fit for you please contact us at info@dentalgrowthstrategies.com or call (204) 813-7775.

GUELPH, ON Well established Oral Surgery Practice in Guelph is looking for an Associate leading to Partnership. Board eligible/ certified is a must. Please email drcooperband@gmail.com

HAMILTON, ON

Looking for a part time associate with excellent communication skills and friendly demeanour to join our team and practice dentistry in a positive relaxed environment. Please email your resume/CV to associatehamilton3@gmail.com

HALIFAX, NS FULL TIME ASSOCIATE Progressive, state of the art clinic, with a well-established patient base, looking for a highly motivated lead Dentist to work in a high paced environment. Preference given to the candidate with the following skill set, wisdom teeth extractions, implant placement, Cerec experience, complicated endo and full mouth rehab. Incentive program available for highly productive individuals. Join our team today and share our philosophy of providing optimal patient care. Email in confidence to annburkevp@gmail.com

NW CALGARY, AB Searching for an extremely motivated Dentist with ideally at least 5 years experience to take over a very busy patient base in NW Calgary. Are you comfortable collaborating in a busy, integrative clinic to guide your patients in decisions regarding their oral health? Are you committed to providing excellent clinical dentistry and improving your skill set with high quality CE? If you are ambitious, positive and want to join an awesome team of professionals, please apply by emailing nwhdentist@gmail.com

SCARBOROUGH, ON

LONDON, ON

Associate Needed

Proactive and passionate dentist needed to add to our growing team. New practice in dense residential area in Scarborough. Only dental office in the neighbourhood. Fantastic opportunity for new grads or 1-2 yrs exp. Available Thursdays and alternate Saturdays. Interested candidates email resumes to:

scarbdoc125@gmail.com

F/T & P/T ASSOCIATES NEEDED Future equity potential for the right candidate(s). Ultramodern, Gorgeous & Paperless. Large 8 op Dental Office opening in late March 2018. Office Open 7 days a week. Must also be willing to do some evenings and either Sat or Sun. E-mail: drfresh@solardental.com

WINDSOR, ON Orthodontic Associate Wanted Established Orthodontic office currently seeking an orthodontist associate. We welcome New Grads! E-mail: ortho@mdirect.net

REXDALE, ON Rexdale Family Practice seeking part time associate for Thursdays, more days in the future. Send resume to amdentalinfo@gmail.com

AD INDEX AMD Medicom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 CDLI â€“ Canadian Dental Laser Institute . . . . . . . . . . . . . . . . . . . .22 Clinical Research Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Crest Oral-B, P&G . . . . . . . . . . . . . . . . . . . . . . . .IFC, 13, 21, 23, 25 Dentsply Sirona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 GC America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 GlaxoSmithKline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IBC Kavo Kerr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 M.C.P. McCaughey Consumer Products Management Inc. . . . . .36 ORALdent Pharma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Philips Oral Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9 Premier Dental Products Company . . . . . . . . . . . . . . . . . . . . . . 43 Sable Industries Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 SciCan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

ST. CATHARINES AREA, ON

Associate needed for new practice in the St. Catharines area. This opportunity is available 2-3 days a week to start, and associates looking to buy in to a practice or own completely are welcome to apply. Please forward your CV to gail@karavosgroup.com

oralhygiene

Sterilog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Sunstar Americas, Inc. . . . . . . . . . . . . . . . . . . . . . 4, 17, 29, 38, 45 VOCO Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OBC Waterpik . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

www.oralhealthgroup.com

MAY 2018

SHE KNOWS THAT STRAWBERRIES HAVE A HIGH ANTIOXIDANT CAPACITY. WHAT ELSE WOULD SHE WANT TO KNOW? Young people today are staying informed to stay healthy.1 But do they know that healthy foods including fruit, juices and sports drinks are highly acidic and can put their enamel at risk?2-5 Exercise your inﬂuence as their trusted dental professional. Help educate every young patient about the effects of acid erosion. Because the investment in their enamel should start today.

For your acid erosion candidate. 1. GSK data on ﬁle, 2013. 2. Lussi A. Erosive tooth wear – a multifactorial condition. In: Lussi A, editor. Dental Erosion – from Diagnosis to Therapy. Karger, Basel, 2006. 3. Lussi A. Eur J Oral Sci. 1996;104:191–198. 4. Hara AT, et al. Caries Research. 2009;43:57–63. 5. Lussi A, et al. Caries Research. 2004;38(suppl 1):34–44.

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